NSG 5000 Assignment 2 leadership and the graduate nursing role

This week’s learning activities are directly related to the following course outcomes: ȸ Differentiate the role and scope of practice of the advanced practice nurses in clinical practice, primary care, education, administration and research. ȸ Identify collaborative, organizational, communication, and leadership skills in working with other professionals in healthcare facilities and/or academic institutions. ȸ Influence health policy using ethical statements, current terminology, classifications, methods, trends. Last week, you learned about the nurse practitioner (NP). You looked at the roles of the nurse educator & administrator & certified registered nurse anesthetist (CRNA) roles of advanced practice nursing. This week, you will learn about the critical elements in managing advanced practice nursing environments. You will review & discuss regulation, licensure, credentialing, consumer choice, competition, financing, & certification. Depending on the role you choose to pursue & the setting in which you will practice, your involvement with each of these areas will vary. Remember, the areas depend on not only your choice of role but also the state within which you will practice. One area that you all need to participate in is health policy. You do not need to go to Washington, D.C., & become a senator (although that would be a good thing!). However, you do need to have an understanding of your practice, the scope & standards of your practice, & the outcomes you can achieve for your clients in particular & the healthcare system in general. Let's begin with two critical elements, negotiation & conflict resolution, in managing advanced practice nursing environment. Learning outcomes Identify collaborative, organizational, communication, & leadership skills in working with other professionals in healthcare facilities &/or academic institutions. Synthesize knowledge from values theory, ethics, & legal/regulatory statutes in the development of a personal philosophy for a career as an advanced practice nurse. Analyze attributes of the practice arena such as access & availability, degree of consumer choice, competition, & financing that impact advanced practice nurses & their ability to effectively collaborate with other health professionals. Negotiation & Conflict Negotiation & conflict are often discussed as part of problem resolution. In fact, early negotiation may prevent conflict development. Merriam-Webster online dictionary (2009) defines negotiation as "the action or process of negotiating or being negotiated." In the advanced practice registered nurse (APRN) role, you may also be involved in finalizing the terms of agreement with your employer. An agreement may be in the form of a position description that details hours, salary, job responsibilities, & expectations for the role. This agreement will form the basis of the legal contract with your employer. As APRNs & other multidisciplinary team members interact, conflicts are bound to occur. Conflicts may be interpersonal or with clients; related to the goal or the treatment; or related to the domain, the practice, or the discipline. Negotiating through a conflict & identifying a suitable resolution is an important skill for an APRN. Negotiation & Conflict Resolution Kitrek (2009) identified conflict resolution in terms of alternative dispute resolution (ADR). The concept of ADR is, however, not used much in the healthcare arena. There are case studies, literature, & research available related to ADR, which need more exploration in terms of application in healthcare. Conflict resolution is a complex skill. You can determine your conflict resolution style by using various tools. One such tool is the Thomas-Kilmann Index (TKI) (Kitrek, 2009), which includes a short questionnaire & a graph with two axes, labeled "assertiveness" & "cooperativeness." The TKI Model Let’s view the conflict-management strategies as depicted in the TKI model: ȸ Competing: Assertiveness & uncooperativeness ȸ Avoiding: Unassertiveness & uncooperativeness ȸ Accommodating: Unassertiveness & cooperativeness ȸ Collaborating: Assertiveness & cooperativeness ȸ Compromising: Intermediate assertiveness & cooperativeness In a conflict, you must first identify the issue. Avoid making snap judgments. As you apply the resolution strategy & work through the issue, you may find that it affects your thinking (Conflict Resolution Network, n.d.; HG.org, 2014) Strengthening Advanced Practice Nursing The healthcare system in the United States focuses on illness & disease-specific problems versus wellness & prevention. In this system, the APRN has a key role & its success depends on several factors, such as the number of APRNs in an organization, the APRNs' functions, & the reporting structure (centralized or decentralized) of the APRNs. Each APRN is responsible for promoting & strengthening his or her role in the organization (American Association of Nurse Practitioners, 2014). Opportunities for ACNPs Before discussing how to strengthen the APRN’s role in organizations, let’s review some opportunities for APRNs. In Week 3, you learned about acute care nurse practitioners (ACNP), who coordinate care for hospitalized clients in nursing units, including intensive care units. Geriatrics With an increasing segment of the population reaching maturity & in need of preventive & illness care, NPs & CNSs who specialize in geriatrics will be in demand. Consider how long- term care & assisted living facilities would benefit from the role of NP or CNS assessment & care planning for clients. Free-Standing Clinics Standing Clinics Based on the number of underinsured or uninsured people in the United States, NPs provide care in free-standing clinics. Again, as the United States has a large elderly population in need of preventive & illness care, the NP’s participation in providing this care will be significant. For-Profit Institutions For more than 20 years, for-profit institutions have been competing with not-for-profit institutions. Many of these for-profit institutions are full-service acute care hospitals, but some are specialty hospitals. All these institutions need a variety of healthcare professionals in order to function. If for-profit institutions can be more cost effective by hiring CRNAs or NPs instead of physicians, more opportunities will be available for the APRNs. You can see that APRNs can practice in various venues. One of the best ways to strengthen advanced practice nursing in an organization is to understand& the various advanced practice nursing roles & the value they can add to the organization. In many instances, the nursing division, department, or service is a significant ally in promoting & employing APRNs. Where you find acceptance & support will depend on the organization. Your ability to articulate advanced practice nursing & practice effectively & efficiently is paramount. Part of your role will be to form relationships with other professionals in the organization who already recognize the value of the APRN's role or who you can educate about the role so that he or she becomes an ally & an advocate. Organizational Structure An important factor to consider in how APRNs are used is the organizational structure. Even within acute care, there can be different work structures, especially when all APRNs do not share the same reporting hierarchy. Some acute care hospitals have adopted service line or product line organizational or reporting structures. These structures are categorized on the basis of age, illness, or the type of care needed. Therefore, if the administrator of the service line or product line is not aware of the value of an APRN, the APRN's role may be underutilized (American Association of Nurse Practitioners, 2014). APRN-Related Service Lines & Product Lines See printout. As you choose your position within an organization, consider the role you are asked to perform. Are you a replacement for a physician & expected to perform exactly as the physician does, or are you sought because you are expected to bring your advanced nursing skills & competencies to care del